Rural primary health care providers can play a vital role in the identification, management, and referral of underage drinkers. This application proposes to continue a program that has successfully engaged 30 rural primary health care providers in the development of a collaborative network for conducting research addressing underage drinking. The Northwest Pennsylvania Adolescent Alcohol Research Cooperative (NPAARC) includes members from the Pittsburgh Adolescent Alcohol Research Center, the Center for Rural Health Practice at the University of Pittsburgh - Bradford campus and primary care practitioners in a rural eight county area. In Phase I, rural practitioners serving underage drinkers participated in a survey on their alcohol-related clinical practices and attitudes. A subset of these practitioners, along with teens and parents, participated in focus groups that explored facilitating and hindering factors influencing alcohol-related screening, brief intervention and referral for treatment. Our Computer Assisted Decision Support for Underage Drinkers (CADSUD) was developed, the assessment component was tested with over 225 adolescents in two practices, and the intervention component will soon be implemented in these practices. With two additional practices scheduled to become involved in 2009, we anticipate that four practices and 800 adolescents will have participated in CADSUD testing during Phase I. in Phase II, CADSUD will be tested in six additional practices with 1200 adolescents. Before their health care visit, these adolescents (12-20 years old) will be assessed via CADSUD on alcohol use and related disorders. To determine the influence of CADSUD, practitioner and adolescent outcomes will be compared during two implementation stages: (1) an assessment only control condition and (2) a full implementation condition including PCP feedback, interpretation of assessments, intervention suggestions, and tailored written materials provided for the patient. Outcomes assessed will include practitioner assessment and referral patterns, patient adherence to referral recommendations, and adolescent alcohol use determined by 2-month and 12-month follow-up assessments. PCPs will be encouraged to utilize CADSUD in community venues and will be provided with related technical support. NPAARC will thus develop, test, and implement a method to address rural underage drinking through primary care practices. PUBLIC HEALTH RELEVANCE: NPAARC will provide clinical tools to practitioners while serving as the platform for intervention research. CADSUD addresses barriers to primary care screening and brief intervention by providing a computer- assisted pre-visit assessment, developmentally appropriate web-based post-visit interventions, and referral suggestions. CADSUD requires limited practitioner training and, if proven effective, could be readily disseminated.